Provider Demographics
NPI:1780641316
Name:TREADWELL, ROBERT CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:TREADWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14131 MIDWAY RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3623
Mailing Address - Country:US
Mailing Address - Phone:972-249-0200
Mailing Address - Fax:972-249-0206
Practice Address - Street 1:14131 MIDWAY RD
Practice Address - Street 2:SUITE 620
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3623
Practice Address - Country:US
Practice Address - Phone:972-249-0200
Practice Address - Fax:972-249-0206
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143111602Medicaid
TX143111602Medicaid
TX8125B7Medicare PIN